Tissue Flap Surgery for Breast Reconstruction

Surgery Overview

Tissue flap surgery is a way to rebuild the
shape of a breast using skin, fat, and muscle from another part of the body. It
is usually done after part or all of the breast is removed (mastectomy) because of cancer. It may also be done for
women who have problems with breast development.

Breast
reconstruction usually takes more than one surgery. The first surgery may be
done during the same surgery as mastectomy, or it may be done later as a
separate procedure. The nipple and the brown area around it (areola) are
created at a later time.

Tissue flap surgery is done by a
plastic surgeon. The breast surgeon who does your
mastectomy can refer you to a plastic surgeon with special training in breast
reconstruction.

You will meet with the plastic surgeon before your
mastectomy to discuss the best procedure for you. The surgeon can show you
pictures of other women who had the surgery you are considering. You can ask to talk to women who have had the surgery.

If you are not comfortable with the surgeon or the recommended treatment,
you can see another surgeon to get a
second opinion.

Types of tissue flap surgery

Tissue flap surgery
may be done in two ways:

"Pedicle flap" means the flap of tissue from
the back or belly is moved to the chest without cutting its original blood
supply. The tissue is pulled under the skin up to the chest area and
attached.

"Free flap" means the tissue and blood vessels are cut.
After the flap is in place, the surgeon sews the blood vessels in the flap to
blood vessels in the chest area. This requires careful surgery using a
microscope.

There are different types of tissue flap surgery, named
for the area of the body where the tissue is taken.

TRAM (transverse rectus abdominis muscle) flap is one of the most common types of flap surgery.
The surgeon takes muscle and tissue from the lower belly and moves it to the
chest area. This reduces the amount of fat and skin in the lower belly and
results in a "tummy tuck." TRAM may be done as either a pedicle flap or a free
flap.

Latissimus dorsi (LD) flap is a type of pedicle flap
surgery. It uses muscle, fat, and skin from the upper back that is pulled under
the skin to the chest area. The scar on the back can be placed at the bra line
to make it less visible. Sometimes an implant is placed during the same surgery
to make the breast larger.

DIEP (deep inferior epigastric artery perforator) flap is a free flap similar to TRAM. The surgeon takes fat
and skin from the lower belly area but doesn't use the muscle. By saving the
muscle, it helps avoid later belly weakness. Like TRAM, it results in a "tummy
tuck."

Gluteal free flap is a free flap that uses muscle,
fat, and skin from the buttocks to create a new breast. This may be a good
choice for thin women who don't have enough belly tissue for DIEP or TRAM.

TUG (transverse
upper gracilis) flap is a free flap that uses tissue from the inner upper thigh to create a new breast.
The scars are hidden inside the thigh and groin. Using the gracilis muscle from the thigh doesn't
leave the leg weaker. This may be a good choice for a woman who has small breasts and little belly
tissue.

What To Expect After Surgery

Tissue flap surgery is done using
general anesthesia, so you sleep during the procedure.
Depending on the procedure, the surgery may take several hours to complete, and
you may need a
blood transfusion.

When you wake up from
surgery, you will have bandages over the surgery sites, and you may wear a
special bra that holds your bandages in place. You will also have drainage
tubes to collect fluid and keep it from building up around the surgery
sites.

You will stay in the hospital about 5 days so your doctor
can be sure there is good blood supply to the skin over the reconstruction. A
physical therapist may show you exercises while you
are still in the hospital. These can help keep your shoulder from getting
stiff.

Most woman have soreness, redness, and swelling in the
breast and the area where the tissue was taken. The swelling may last for
several weeks. You may need pain medicine for a week or two. Your doctor may
also prescribe
antibiotics to help prevent infection.

You may be able to go back to work or your normal routine in 3 to 6
weeks. Most women need to avoid strenuous activity for several weeks.

Why It Is Done

Tissue flap surgery is usually done to
restore the appearance of a breast after mastectomy. It may also be done for
women who have problems with breast development.

Breast
reconstruction may help a woman feel better about her appearance. Some women
say it helps them feel better about their bodies, more alive,
feminine, and sexual—and happier about life.

How Well It Works

Most women who have tissue flap
surgery are happy with the results. Compared to breast reconstruction with
implants, tissue flap procedures require a longer surgery and recovery time but
result in a more natural-looking breast.

Breast reconstruction
cannot restore normal feeling to your breast, but with time, some feeling may
return.

Risks

Many of the risks associated with breast
reconstruction are the same as those with any surgery: infection, poor wound
healing, bleeding, or a reaction to the anesthesia used in surgery.

Other risks associated with tissue flap surgery include:

Tissue death if blood supply to the flap is not
restored. This could cause the need for more surgery.

Collection of
blood or clear fluid in the wound.

Ongoing pain or discomfort in
the breast area.

Muscle weakness in the area where muscle is
removed.

Abnormal scarring.

Some women are at higher risk for problems, so tissue flap
surgery may not be a good choice for them. This includes women who:

Are obese.

Have
high blood pressure.

Have
diabetes.

Smoke.

Are in poor
health.

What To Think About

If you will need to have
radiation therapy after mastectomy for breast cancer,
your surgeon may want you to wait and have reconstruction after your treatment.
Radiation can affect the success of tissue flap surgery.

If you
can choose when to have surgery, be sure to discuss the pros and cons of having
it at the same time as mastectomy and the pros and cons of waiting until later.
Some women want to get started with reconstruction right away. Others may feel
overwhelmed by a cancer diagnosis, so they put off the decision to have
reconstruction until they feel ready to deal with it. Be sure you understand
your options.

It is important to know that your breasts will look
different after surgery. Your new breast may feel firmer and look rounder or
flatter than your other breast. Some women have surgery on the other breast to
make them look as much alike as possible.

Breast reconstruction
can be a long process. It may take several months for your breast to heal. And
it may be a year before you can see the final result.

The
incisions will leave scars on your breasts and wherever the tissue was taken.
These will fade with time. The surgeon will try to make incisions that leave as
few scars as possible.

Federal law requires insurance companies
that cover mastectomy for breast cancer to also cover breast reconstruction.
Check with your insurance company to find out what your costs will be.

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